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For further information, see CMDT Part 6-18: Miscellaneous Scaling Dermatoses

Key Features

  • Actinic keratoses are considered premalignant, but 1:1000 lesions/year progresses to squamous cell carcinoma

Clinical Findings

  • Actinic keratoses are small (0.2–0.6 cm) macules or papules—flesh-colored, pink, or slightly hyperpigmented—that feel like sandpaper and are tender to palpation

  • They occur on sun-exposed parts of the body in persons of fair complexion


  • Clinical

  • Differential diagnosis

    • Squamous cell carcinoma

    • Bowen disease (squamous cell carcinoma in situ)

    • Nonpigmented seborrheic keratosis

    • Psoriasis

    • Seborrheic dermatitis

    • Seborrheic keratosis

    • Paget disease


  • Liquid nitrogen provides rapid eradication of lesions, which crust and disappear in 10–14 days

  • Topical agents may be considered in patients with multiple lesions in one area (eg, forehead, dorsal hands) and include

    • Fluorouracil

    • Imiquimod

    • Ingenol mebutate

  • Photodynamic therapy can be effective in refractory cases

  • Combination therapy may be clinically beneficial

  • Lesions that persist should be evaluated for possible biopsy

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